Exit Interview Survey printable pdf download

EXIT INTERVIEW SURVEY

Instructions: The exit interview is an opportunity to obtain valuable information about

perceptions, frustrations and areas in need of improvement. The Exit Interview Survey is

designed to gather information in a consistent non-threatening manner. Although written

in survey format, each department is encouraged to identify a neutral third party to meet

one on one with the employee and gather information orally. The exit interview is

voluntary but strongly encouraged.

After the information is gathered the department should complete the lower section of the

form and submit to the Employee Relations Office (Room 213 Scovell Hall, 0064), Human

Resource Services. The form does not require a name and does not become part of any

personnel file. The focus is not on “who said what” rather to assist in identifying factors

which contribute to dissatisfaction and turnover.

1. Describe the circumstances that have lead you to resign or separate:

2. Mark any of the following that are reason(s) for your resignation or separation:

Check mark all that apply

Ο Supervisor

Ο Work hours

Ο Job security

Ο Stress

Ο Staffing level

Ο Grade of position

Ο Benefits

Ο Overtime requirements

Ο Lack of information

Ο Pay

Ο Potential layoff

Ο Training and development

Ο Job responsibility

Ο Equipment and supplies

Ο Co-workers

Ο Promotional

Ο Management above

Ο Physical working conditions

opportunities

supervisor

3. If “Supervisor” or “Management above supervisor” is check marked above, complete

the following questions:

Supervisor

Above

How well does your

supervisor or management above

supervisor…

Ineffective

Effective

Ineffective

Effective

A. Recognize problems needing

improvement

B. Understand employees' skills,

abilities and commitment

C. Organize and coordinate

department activities to solve

problems

D. Recognize the department's role in

addressing University needs

E. Select plans to address the cause of

problems

F. Recognize and act on

opportunities to solve problems

G. Maintain an environment of open

communication

Exit Interview Survey

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